Nerve-sparing open radical prostatectomy with extracapsular dissection

Background. - Potency recovery after radical prostatectomy (RP) has to be weighed against the risks of nerve-sparing surgery in relation to tong-term cancer control. Objective. - To apply quality control criteria for RP, define the risk of iatrogenic positive margins and evaluate nerve-sparing dissection and sexual outcomes. Intervention. - Nerve-sparing retropubic RP with "extracapsular" dissection. Method. - Histopathology : whole-mount 3-mm serial sections from the prostate apex to base using the Stanford technique. Recovery of erectile function evaluated with the abridged version of the International Index for Erectile Function (IIEF-5). Results. - Prospective study about 507 consecutive RP candidates. Bilateral nerve-sparing (n=273, 88.1 %), unilateral (n=37, 11.9 %). The risk of iatrogenic positive margins was 5 %. The positive surgical margin rate was 6.3 % (2.2 % for pT2 and 14.5 % for pT3). The potency recovery rate with or without type 5 phosphodiesterase inhibitor assistance was 83.5 % at 1 year and 95.1 % at 2 years. Conclusion. - Nerve-sparing can be performed in a dissection plane outside the boundaries of the capsule, thus ensuring oncologicat safety whilst providing highly satisfactory potency recovery rates. (C) 2009 Published by Elsevier Masson SAS.